When 18 years of age she was working very hard preparing for some examinations, and worried lest she should fail in them. Some years later the patient accounted for her psychosis by saying she had a quarrel with her sister, immediately after which she began to feel depressed. The anamnesis states that she was slow, complained of not being able to think and feeling as if she had no brain. She was sent to a general hospital, where she was apprehensive, wanted her mother to stay with her and one night called out "Mother."
The case being recognized after a few days as a psychosis, she was sent to the Observation Pavilion, where she was described as jumping about in bed in a jerky, purposeless manner, resistive when anything was done for her, and mute. Her sister reported that when she visited her the patient said "Go away, I am dead."
On admission she looked dazed, stared vacantly and had a tendency to draw the sheet over her. When put on her feet she let herself fall limply. At times she became agitated, sobbed and cried loudly, especially when attempts were made to examine her physically, or, when she was asked questions, she scarcely spoke.
Her psychosis lasted but a little more than three months under observation and was characterized by the following symptoms: She was usually in bed, staring blankly or appearing otherwise quite indifferent and apathetic, but not infrequently, especially during the first few weeks, she was quite restless, resistive, whined and suddenly appeared startled or distressed with no occasion for this reaction in the environment. Rarely she was suddenly assaultive. When attempts were made to examine her, she was frequently mute or would repeat the question with a rising inflection, not getting anywhere, or would say, "What shall I say," or "I, I——" never finishing her sentence. After orientation questions she might say "This is—this is—this is——" all this, together with a rather perplexed appearance, gave the impression of considerable bewilderment, but at no time did she complain of autopsychic perplexity. It was difficult to judge of her orientation on account of her failure to answer questions, but it soon appeared that she knew the names of the nurses, for she sometimes called them spontaneously by name. She always ate reluctantly.
During these examinations, however, other symptoms often appeared. When she was talked to, she was apt to indulge in depressive statements and show considerable distress. Such remarks were: "I must confess my guilt," "I am a bad girl and I have to face my guilt," or "I have sinned," or, standing up with a dramatic air, "I must stand up and tell the truth." Once she said, "It is too late to live now." She spoke of having lied and usually would not say what about, but once on questioning replied "I said I would not tell what happened here." She was asked,
What do you mean? and answered "I took my oath not to tell anything." Pressed further she said that the nurses poisoned her. Another time she said she was in prison. To her aunt who visited her she said, "I am a prostitute," and once she remarked to the doctor, "I have killed my honor," and on another occasion in the middle of the night she called out, "Chinatown Charlie, come here." She thought the doctor was her brother.
Most of these statements were associated with painful emotion, but there were a few occasions when an element of elation cropped out. Thus on one occasion she laughed, another time gripped the doctor's pad and tried to read it. When the nurse laughed, she made a funny grimace at her and said "Why do you laugh?" Again she once sang two songs, but after the first verse got stuck and kept repeating one word.
At the end of three months she improved rather rapidly and was in a condition for discharge as "recovered" a month later. Retrospectively she said that she recalled feeling guilty, thinking that her mother was dead, having been killed by the patient as a result of worrying over the latter's failure in her examinations and refusal to eat. She remembered, too, that at times she thought the building was burning. Some things like "Chinatown Charlie" she denied remembering, although she had a good recollection for the external facts throughout the psychosis. Her insight was superficially good, but she was reluctant to discuss her psychosis, in fact claimed that she had been made more of a lunatic by coming to the hospital than she was on admission.
Some five years later she had another somewhat similar attack, again following a quarrel, this time with a fellow employee. In this second psychosis, however, manic elements were much more prominent.
Here again, then, we have the symptoms of apparent apathy, inactivity, and similar ideas of death, but the thinking disorder was possibly not very profound, inasmuch as she had a good memory for external events. Her ideas, too, are much more florid than those which we customarily meet with in stupor cases, but the most marked peculiarity was